Malignancy of the stomach ulcer

According to modern data, the frequency of malignant stomach ulcers does not exceed 2%. The data of previous years were overestimated. This is due to the fact that for the malignant stomach ulcer the primary gastric ulcer was taken, which in clinical course almost does not differ from chronic gastric ulcer. In addition, the primary-ulcerative form of stomach cancer for a fairly long time can proceed without generalization of the process and give periods of remission with healing of the ulcer. At the same time, a good appetite and a satisfactory condition of the patient remain.

[1], [2], [3], [4], [5], [6], [7],

Symptoms of the malignant stomach ulcers

The gastric malignancy can be established on the basis of the following symptoms:

• pain in the epigastric region becomes permanent, irradiates in the back, especially intense pain occurs at night;
• disappears symptom locality pain during palpation, pain in epigastrium becomes diffuse;
• there is a progressive drop in the patient's body weight;
• appetite disappears;
• there is an unmotivated growing weakness.

Diagnostics of the malignant stomach ulcers

• characterized by progressive anemia, the constantly positive response of Gregersen (reaction to latent blood in the stool) and persistent decrease in the acidity of gastric juice, the detection of lactic acid in it; persistent increase in ESR;
• with x-rays of the stomach, signs of malignancy of the ulcer are revealed: a wide entrance to the ulcer crater, an atypical relief of the mucosa around the "niche", the disappearance of folds and peristalsis in the affected segment, the infiltration shaft around the ulcer exceeds the diameter of the ulcer crater, the symptom of the submerged niche, the appearance of a filling defect;
• at FEGS there are characteristic signs of a "malignant ulcer". Such ulcers often have an irregular shape, uneven, fuzzy, bumpy edges. The bottom of the ulcer is also uneven, tuberous, may be flat, shallow, covered with a grayish coating. In some areas of the ulcer, the edges may be undermined. Characterized by diffuse infiltration and deformation of the stomach wall in the area of the ulcer. A frequent sign is the rigidity of the edges of the ulcer during the targeted biopsy and increased bleeding in the area of ulcerative lesions. On the mucous membrane surrounding the ulcer, there are erosions. For a final judgment on the nature of the ulcer, it is necessary to perform a targeted biopsy from the edges and bottom of the ulcer in several areas (no less than 5-6 biopsy specimens) followed by histological and cytological examination of the material.

[8], [9], [10], [11], [12], [13], [14], [15], [16], [17]